A 24-year-old woman in her third trimester of pregnancy presents with acute onset jaundice, fever, and malaise. Laboratory studies show total bilirubin 8.5 mg/dL, ALT 1280 IU/L, AST 1100 INR, INR 1.8. Serology is negative for HBsAg, anti-HCV, and anti-HAV IgM. Which organism is the most likely cause?

• A Hepatitis A virus
• B Hepatitis B virus
• C Hepatitis C virus
• D Hepatitis E virus ✓

Explanation

Hepatitis E virus (HEV) causes epidemic hepatitis in endemic regions and carries a particularly high mortality in pregnant women, especially during the third trimester, with fulminant hepatic failure rates reaching 15-25%. The clinical picture of acute hepatitis in pregnancy with negative HAV, HBV, and HCV serology strongly points to HEV. Indian exam convention emphasizes HEV as the leading cause of acute liver failure in pregnancy in the subcontinent.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.